副戈登分枝杆菌性角膜炎1例  

A case of Mycobacterium paracondontium keratitis

作　　者：林通 王艳 LIN Tong;WANG Yan(Department of Ophthalmology,Eye&ENT Hospital of Fudan University,Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,上海200031

出　　处：《中国眼耳鼻喉科杂志》2024年第S01期33-37,共5页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：43岁女性,主诉左眼反复红痛4年余,伴视物模糊2年余。患者起病时,以左眼反复晨起时红痛流泪为特点,结合既往有左眼角膜划伤外伤诱因以及近视激光矫正手术史,考虑左眼复发性角膜上皮糜烂。此后患者出现左眼中央灰白色病灶,边界不清,角膜基质雾状水肿,但病原学检测均为阴性,经验性的抗细菌及抗真菌治疗后好转。之后患者感染新型冠状病毒后症状反复,又呈现出病毒性角膜炎的特征,诊断性治疗好转后又出现了角膜表面坏死灶和卫星灶的表现。后收入院行左眼角膜清创活检术,术中取坏死组织送宏基因组检测,最终明确副戈登分枝杆菌感染,术后予以阿米卡星及加替沙星局部抗感染治疗后病情得到控制。讨论体会:副戈登分枝杆菌性角膜炎的临床表现有一定伪装性,对于有近视激光手术史的不典型角膜炎表现时需警惕非结核分枝杆菌感染。常规病原检查难以明确病因时可借助宏基因组检测来及早诊断。对于非结核分枝杆菌性角膜炎,敏感抗生素局部治疗应足量、足疗程、防毒副作用,必要时采用角膜瓣切除开放创面。A 43-year-old female complained of repeated redness and pain in her left eye for more than 4 years,accompanied by blurred vision for more than 2 years.The diagnose of recurrent corneal epithelial erosion was considered in combination with the previous trauma of corneal scratch in her left eye and the history of myopia laser correction surgery.Subsequently,the patient developed a grayish-white lesion in the central cornea of the left eye with unclear boundaries and misty corneal stromal edema,but the pathogen tests were negative.The symptoms improved after empirical anti-bacterial and anti-fungal treatment,but repeated after COVID-19 infection,presenting the characteristics of viral keratitis.The diagnostic treatment relieved symptoms,yet the manifestations of corneal surface necrosis and satellite lesions appeared again.The patient was admitted for corneal debridement biopsy.The necrotic tissue taken during the operation was sent for metagenomic detection.The infection of Mycobacterium was identified.After the operation,topical amikacin and gatifloxacin were administered and the keratitis was finally controlled.In conclusion,the clinical manifestations of Mycobacterium keratitis have certain camouflage,and we should be vigilant about the nontuberculous mycobacterium for atypical cases of keratitis with a history of myopia laser surgery.Metagenomic detection can be used for early diagnosis when routine pathogen examination fails to identify the pathogen.For non-tuberculous mycobacterium keratitis,a full course of topical treatment with sensitive antibiotics should be administered in sufficient dosage,with the caution of avoiding of side effects.If necessary,corneal flap excision can be conducted as adjuvant therapy.

关 键 词：复发性角膜上皮糜烂 非结核分枝杆菌 近视激光手术 宏基因组 

分 类 号：R772.21[医药卫生—眼科]